Pharmacometric modeling establishes causal quantitative relationships between administered dose, tissue exposures, desired and undesired effects and patient’s risk factors. These models are employed to de-risk drug development and guide precision medicine decisions. However, pharmacometric tools have not been designed to handle today’s heterogeneous big data and complex models. We set out to design a platform that facilitates domain-specific modeling and its integration with modern analytics to foster innovation and readiness in healthcare. Pumas demonstrates estimation methodologies with dramatic performance advances. New ODE solver algorithms, such as coeficient-optimized higher order integrators and new automatic stiffness detecting algorithms which are robust to frequent discontinuities, give rise to a median 4x performance improvement across a wide range of stiff and non-stiff systems seen in pharmacometric applications. These methods combine with JIT compiler techniques, such as statically-sized optimizations and discrete sensitivity analysis via forward-mode automatic differentiation, to further enhance the accuracy and performance of the solving and parameter estimation process. We demonstrate that when all of these techniques are combined with a validated clinical trial dosing mechanism and non-compartmental analysis (NCA) suite, real applications like NLME fitting see a median 81x acceleration while retaining the same accuracy. Meanwhile in areas with less prior software optimization, like optimal experimental design, we see orders of magnitude performance enhancements over competitors. Further, Pumas combines these technical advances with several workflows that are automated and designed to boost productivity of the day-to-day user activity. Together we show a fast pharmacometric modeling framework for next-generation precision analytics.